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PubMed1990

Mobilizing fundamental modes of development: empathic availability and therapeutic action.

A positive developmental thrust becomes mobilized by virtue of therapeutic action. This thrust is specified in terms of a set of fundamental modes of development that are biologically prepared and have been identified through recent research. The modes are first apparent in infancy and continue throughout life. The setting conditions which allow for the fundamental modes of development to be reactivated are provided by the therapeutic relationship. It is hypothesized that the empathic availability of the therapist enables these modes to operate as powerful background influences. Developmental aspects of empathy and of availability highlight the importance of adult regulatory functions and the construction of shared meaning.

Creativity↗
PubMed1990

Developmental psychology and psychoanalysis: I. The context for a revolution in psychoanalysis.

After describing the manner in which the integration of psychoanalysis and developmental psychology became a central problem for ego psychology, the author examines the conditions that make it possible for new research and theory in developmental psychology to contribute to a revolution in contemporary psychoanalytic theory. They include: (1) the emergence of a state of "crisis" in American psychoanalysis centering on questions of the nature of early development and how it can be known; (2) the explosive growth of developmental research on early childhood dealing with issues at the heart of that crisis; and (3) the presence of a new generation of psychoanalysts and psychoanalytically oriented researchers capable of bringing that research to bear on those issues.

Ego↗
PubMed1990

The nature of therapeutic action in psychoanalysis.

The nature of therapeutic action varies not only with each patient's psychological predilection for utilizing opportunities for change, but also with the manner in which the analyst or therapist presents opportunity for change. Ideally, the therapist bases the latter on personally identifiable theoretical concepts and aims. This inquiry focuses on a relatively narrow field of clinical material in order to provide as close as possible an examination of therapeutic action. The technical approach provides opportunities for change, minimizing alterations resulting from internalizing processes or suggestion. The therapeutic actions arise from analyst and patient sharing observations of the patient's intrapsychic activities of resistance to drive derivatives the patient briefly allowed into consciousness, and represent processes of ego maturation set in motion by intellectually gained and experientially exercised insights.

Adult↗
PubMed1991

Abstract art and emotion: expressive form and the sense of wholeness.

This paper limits itself to abstract art the better to concentrate on the relation between the emotionally expressive power of esthetic form--apart from its narrative content--and emotional responsiveness. The emotionally expressive power of art--not to be confused with the artist's own emotions--has to do with the way sensuous esthetic forms highlight the rhythmic changes of tension and release inherent in ordinary perceptual experience. Tension and release are useful terms in thinking about how the perception of an esthetic structure is transformed (transduced) into feelingful psychological meanings, and contributes to the subjective sense of wholeness. The sense of wholeness may be illusory and/or authentic depending on the mix of elements in the individual's responsiveness. It comes about through a unified organization of tension and release, as embodied in expressive forms such as rhythm and rhyme, resonating with tension and release evoked in the observer's associations to such psychological issues as separation and reunion. Having stirred the viewer's emotional responsiveness, the art work provides a reliable "container" for the objectification of latent emotions.

Art↗
PubMed1991

Some comments on masochism and the delusion of omnipotence from a developmental perspective.

This paper explores the relation of the delusion of omnipotence to masochism and suggests that this fantasy constitutes a major component of the resistance so prominent in work with masochistic patients. The connections among masochism, omnipotence, negative therapeutic reaction, and clinging to pain are discussed. The classical view has been that the failure of infantile omnipotence forces the child to turn to reality. Our experience with masochistic patients suggests that it is the real failure to achieve competent interactions with others that forces the child to turn to omnipotent solutions. The distinction is made between fantasies that enhance the real capacities of the self and those aimed at denying and transforming the pain and inadequacy of the mother-child relationship. The epigenetic transformations of omnipotent fantasies through all levels of development are described. The patient's need to protect the omnipotent fantasy is discussed in relation to resistance at each phase of analysis.

Defense Mechanisms↗
PubMed1991

Sadomasochism in the neuroses conceived of as a pathological compromise formation.

Masochistic phenomena in adults are discussed as derivatives of conscious and/or unconscious fantasies. These masochistic fantasies are always associated with conscious and/or unconscious narcissistic and sadistic fantasies. These fantasies, like all fantasies in adults, are conceived of as compromise formations. After a selected review of the literature, analytic data are presented to highlight the clinical advantages of a contemporary elaboration of the structural hypothesis for the understanding of sadomasochistic and sadonarcissistic phenomena.

Adult↗
PubMed1991

The dread to repeat: comments on the working-through process in psychoanalysis.

This paper focuses on the process of working through in psychoanalysis. Reemphasis of the centrality of the empathic listening perspective and discovery of the selfobject transferences made it necessary to reconceptualize various aspects of the analytic process from the perspective of psychoanalytic self psychology. With the help of a clinical vignette, the paper illustrates the manner in which archaic defense organizations and newly developing psychic structures find a compromise solution in a transference symptom. Such symptoms can serve as nodal points in the process of working through; they represent a transitional phase between the old automatic responses to narcissistic injury and an increased capacity to use signal anxiety. The psychopathology that became illuminated in this process can be described phenomenologically as a self-defeating personality disorder.

Adult↗
PubMed1991

Sadomasochism in the perversions: some thoughts on the destruction of reality.

The author summarizes and develops some of her viewpoints on the perversions (outlined in several of the books and articles she has written). For her all the perversions, whatever their content, develop against an anal sadomasochistic backdrop. Their aim is to destroy reality. Reality, from a psychosexual perspective, may be defined as resulting from the existence of the father separating the mother and the child. This may be formulated in another way: reality is recognition of sexual and generational differences. Or, yet again: mother and father have a procreative sexuality, whereas the child does not. This leads to the idea that the destruction of reality is equivalent to destruction of the paternal universe. Clinical case illustrations are provided, one of which centers on the assassination of an old man who, besides representing a paternal oedipal image, also represents reality itself. This case illustrates in concrete form the murder of the father, and hence of reality, accomplished by the pervert when he eradicates the paternal dimension of psychosexuality by regressing to the anal sadomasochistic dimension.

Fantasy↗
PubMed1991

Beyond the what, when, and how of transference: a consideration of the why.

Transference has generally been discussed in terms of its operating to distort the way in which a current relationship is dealt with and experienced because of one's past. In the present paper, emphasis is placed on that aspect of transference which operates as a defense, and which is called into play in response to signal anxiety associated with a "pathogenic complex" and is based on (1) a traumatic experience of stimulus overload or (2) an intrapsychic conflict stemming from instinctual drive pressure which in turn threatens a repetition of the traumatic experience. Clinical illustrations are presented in which both traumatic experience and drive-conflict forces are prominent, leading to a discussion of the here-and-now versus reconstruction of the past, as well as affective/cognitive and interpersonal/intrapsychic factors.

Adult↗
PubMed1991

On methods of reporting clinical material.

The members of the Committee on Scientific Activities of the American Psychoanalytic Association are concerned about the paucity of clinical data in psychoanalytic reports and by the quality of what does exist. We have proposed a few standards for clinical reports that we believe will be reliable and clear and will have enduring usefulness. We recognize the need for maintaining confidentiality and, at times, for disguise; we also recognize the need to balance these requirements against the dangers of misleading the reader (or listener). These conflicting requirements have resulted in our concentrating on some general principles for clinical reporting. We have appended a tentative form, and examples, to be considered for that purpose.

Data Collection↗
PubMed1992

Some thoughts on the psychoanalytic situation.

This article develops ideas set out in a previous study on the "archaic matrix of the Oedipus complex" versus the fully developed Oedipus complex (their similarities and their differences), applying these to a study of the psychoanalytic situation. The central hypothesis is that there is a correspondence between the psychoanalytic situation and the structure of the mental apparatus. The author supposes that our perception of the world is intimately linked to the primary maternal relationship, to our wish to fuse with the mother once more, and to the accompanying fear such a wish inspires. To deal with this we create enclaves where the regressive wish can be satisfied without fear of ego dissolution. The author suggests that the psychoanalytic situation is one such enclave. She examines its specific features in the light of the structure of the mental apparatus as she defines it.

Adult↗
PubMed1992

Hierarchies, boundaries, and representation in a Freudian model of mental organization.

Freud used a spatial model of mental organization, derived from his explanation of aphasia, as an organizing framework for psychoanalytic theory. He introduced the ideas of representation and overdetermination to describe relations of the contents of systems that were joined to form, first, a hierarchical nervous system, then, mental systems. Freud used his basic model to organize aspects of mental function and phenomena, of interpersonal and social phenomena, and some kinds of biological phenomena. His accounts of metapsychology and clinical psychoanalysis are similar to his description of the basic aphasia/nervous system model. Across the boundaries of mental systems, translation of the contents of one system led to their being represented in another. Repeated editing and translation account for many properties of the systems. The mind pictured is a hierarchical structure of agencies, functions, and fantasy organizations. Complexity results from the combination of relatively simple relations and repetition of the same operations. The mind described by Freud's psychoanalysis is the self-reflecting mind and the mental activity of an analyst and of a patient in analysis.

Aphasia↗
PubMed1992

The analyst's mistakes.

The analyst's mistakes are an inevitable aspect of his conduct of psychoanalysis. They result from the inherent uncertainties and ambiguities of the analytic process itself, and from the continuing effect upon analytic technique of the analyst's unresolved conflicts, as manifested in countertransference attitudes and enactments. Variables of clinical experience, skill, and the vicissitudes of the analyst's life also contribute to the susceptibility to error. When the analyst's mistakes result from his active engagement in the psychoanalytic process, they yield important clues for understanding clinical material as well as present potential obstacles to analytic progress.

Adolescent↗
PubMed1992

Model scenes: implications for psychoanalytic treatment.

Model scenes are constructed by analyst and patient to organize puzzling information, integrate previous understanding, and initiate further exploration of experience. They are derived from a variety of sources: literature (oedipal myth); transference; ordinary or traumatic childhood events that occupy a pivotal position. Model scenes may conceptualize experiences of any age and motivational system, and are contrasted with screen memories and "telescoping" of events. Two clinical examples are used to illustrate the relation between the model scene and the transference. Model scenes provide a valuable clinical tool for moving from general to specific experience. They afford empathic entry into the transference experience and the opportunity through which the experience of motivations representative of past and present can be conceptualized and integrated into a cohesive self organization.

Adult↗
PubMed1992

The analyst's style and its impact on the analytic process: overcoming a patient-analyst stalemate.

Analysts have characteristic styles in working with their patients. At times of crisis or stalemate, an alteration in style may facilitate the progress of the treatment. To illustrate the impeding effects of an analytic style at a particular phase of analysis, I describe a stalemate in the analysis of a severely self-critical patient. Recognition of the limiting effects of style on the treatment became apparent in a countertransference enactment, influenced by the patient-analyst match. Self-analysis and alteration in the characteristic style of the analyst resolved the stalemate and enabled the analytic work to progress.

Adult↗
PubMed1992

A case of premenstrual distress: bisexual determinants of a woman's fantasy of damage to her genital.

Case material is used to illustrate specific clinical application of the concept of primary femininity. Some contemporary contributions to the psychoanalytic theory of female psychosexual development are presented as complementary with, rather than contradictory to, more familiar, longstanding formulations that emphasize phallic strivings in women. In the clinical example reported, a fantasy of genital damage underlay a woman's premenstrual distress. Aspirations and concerns related to both aspects of her fundamental bisexuality participated in symptom formation and had to be investigated in order to achieve symptom relief. As the analytic work unfolded, it could be seen that the patient's awareness of her feminine aims served to keep her masculine aims out of awareness, and vice versa.

Adult↗
PubMed1992

Memory as resistance, and the telling of a dream.

Traditional analytic orientation to memory as subject to repression has overshadowed examination of some of the ego's other activities bearing on memory. The author examines the defensive use of memory with the analytic goal of maximum autonomous access for the patient to the ego's previously unconscious management of intrapsychic conflict. A close scrutiny of an example of this in the form of the telling of a dream explores this resistance process and illustrates a technical approach. Some aspects of this perspective are considered in relation to traditional approaches to dream material. Certain technical priorities for differing clinical settings are discussed.

Adult↗